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What is an “exacerbation,” “relapse,” or “attack” and how do I know if I’m having one?

These terms all define a period of time when symptoms suddenly appear or become significantly worse.  Doctors consider an exacerbation an onset of new or worsening symptoms due to a new lesion or area of disease activity.  It is important to notify your doctor of any new symptoms or worsening right away.  They will help you determine what is going on and how to address it. 

In relapsing forms of MS, the body will have stretches of time when you are experiencing symptoms and then quiet times when you feel relatively “normal.”  During those quiet times the body can heal some or all of the damage and your symptoms may improve dramatically. This is a process known as “remyelination.”  A lot of the current research, by groups like the Myelin Project, is focused on how to foster that process.  The body’s ability to heal can be truly amazing.  Plenty of veterans of MS will tell you that they have recovered from severe exacerbations and gone on to do all kinds of things they didn’t think were possible. Some exacerbations are followed by partial recoveries.  When these add up over time, they can create “accumulated disability.”  This is one of the chief reasons to begin on a disease-modifying drug protocol right away.  The current drugs demonstrate an ability to reduce the frequency of exacerbations, the severity/number of active lesions, and the accumulation of disability.  A few are also are thought to help protect the nerves during an exacerbation.

In progressive forms of MS, there are few or no defined exacerbations with remissive periods of recovery.  This chronic disease activity requires a different approach to treatment.  There are a number of options that have proven to help alleviate symptoms and/or improving function.